If anyone you know came to you and said,

“For the last few weeks I have noticed that nothing gives me any pleasure; I don’t feel interested in anything; I feel quite hopeless and I sleep all the time. Some days I can’t sleep at all and feel terribly restless and fidgety; I feel wretched about myself all the time and hardly feel like eating anything. I feel really tired and can hardly focus on anything. This has been getting worse for a few weeks but for the last 2 weeks, almost everyday the thought has occurred to me that I would be better off dead or hurting myself in some way. All these things have made it extremely difficult for me to do my work, take care of things at home or get along with other people.”, what would you think?

They are suffering deeply.

This is what a PHQ-9 score of 27/27 looks like.
This day last year, my son’s score was 27/27.
It had been 19/27 two weeks prior but had since risen.
I had noted the deterioration in his state of mind.
The words my son could not utter, he indicated on paper.
He was suffering deeply but sadly his suffering was not acknowledged by the professionals who we trusted to care for him.

If clinical judgement had been astute enough, we would have picked up on it and possibly turned it around – escalated care, reviewed medications, reviewed dosages, taken him to A&E.

If a patient with diabetes had a dangerously low blood sugar or another one with Hypertension had a sky rocketing blood pressure, would we just ignore it?

The investigation report mentions the PHQ-9 test as a ‘blunt instrument’. If that is the case, why is it used so widely? Why is it a well-recognized monitoring tool for patients with depression? How can it be ignored when a patient has the highest possible scores?

A baseball bat is a blunt instrument. But it has its uses. It can take a team to victory and crack a skull.

In the light of what I know now, it is not surprising that my son died of severe depression. In fact, it is surprising that he hung on for as long as he did.

Just because the patient is sitting and talking to us and there are no lumps and bumps, no obvious bleeding or pain, does not mean they are not suffering. They are slowly dying in front of our eyes. Their suffering is so unbearable that they will do anything to get rid of it. They are ashamed of it and can’t bring themselves to talk about the extent of it.

We need to learn to pick up on subtle signs.

When it comes to suicide, prevention is the only cure.